Accepted for/Published in: JMIR Formative Research
Date Submitted: Feb 8, 2021
Date Accepted: Sep 18, 2021
Population-Based Cirrhosis Identification and Management System (P-CIMS) for Improving Cirrhosis Care: A Qualitative Formative Evaluation of a Web-Based Tool
ABSTRACT
Background:
Cirrhosis, or scarring of the liver, is a debilitating condition affecting millions of U.S. adults. Early identification, linkage to care, and retention in care are critical to preventing severe complications from cirrhosis and death.
Objective:
The purpose of this study was to conduct a pre-implementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management.
Methods:
Semi-structured interviews were conducted with frontline providers in liver disease and primary care clinics at three Veterans Health Administration medical centers. The Consolidated Framework for Implementation Research guided the development of interview guides. Inductive consensus coding was used to analyze transcribed interviews and abstracted coded passages elucidated themes and insights.
Results:
Ten providers were interviewed, including eight physicians and mid-level providers from liver-related specialty clinics and two primary care providers who managed patients with cirrhosis. Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability.
Conclusions:
P-CIMS shows promise as a powerful tool for identifying, linking, and retaining in care patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in chronic disease populations.
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